Proper Management of a Phobic Patient to Complete Comprehnsive Dental Care: Case Report
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1 report imedpub Journals Proper Management of a Phobic Patient to Complete Comprehnsive Dental Care: Report Abstract Performing dental treatment on fearful and anxious patient can be a daunting task, both for the healthcare provider as well as the patient. Approximately 7 to 10% of Americans experience dental phobia, leading to avoidance of dental treatment and delaying dental care as they only present during emergencies and palliative care. Proper understanding and management of the patient s chief concern during the emergency visit is essential to gain patient s trust to continue comprehensive treatment. The purpose of this case report is to describe how a 40-year old female with dental phobia who presented as an emergency with pain and swelling in the right cheek, was properly managed by a general care practitioner allowing her continue comprehensive evaluation and treatment which including several surgical procedures. This report highlights the concerns, history, diagnosis, and management of a patient with dental phobia. Keywords: Dental care; Anxiety; Implants; Radiographic examination; Laser Tasadaq Khakwani, Suhasini Mandiga, Natalia Elson and Denise Foran New York University College of Dentistry, NY, USA Corresponding author: Natalia Elson Clinical Instructor, NYU College of Dentistry, Cariology and Comprehensive Care, 345 E.24th Street, New York, NY, USA. natalia.elson@gmail.com Tel: Received: October 12, ; Accepted: December 02, ; Published: December 10, Background According to recent studies at Columbia Dental School and the University of Washington, approximately 50% of the American population i.e. 30 to 40 million people, avoid dental care as a direct result of anxiety and fear [1]. Studies have demonstrated a strong association between dental fear, poor oral health, and adverse childhood experiences such as domestic violence, parental incarceration, mental illness, access to healthcare and utilization, and drug abuse. Presence of an adverse childhood event increases the risk of developing oral diseases due to racial and socioeconomic factors, and dental phobia [2]. Dental fear is the primary reason a patient is referred for sedation to receive dental treatment [3]. Over recent decades, the everyday clinical practice of dentistry has benefited from major advances in techniques, technologies and materials, as well as in infection control procedures [4]. With the advent of laserchairside time is reduced and their painless and bloodless procedures further ensure patient comfort during treatment [5]. Authors have the phobic patients who is coming only because of laser is being used. This suggests, a proper behavioral management is essential in treating these patients adequately. Many patients are able to overcome dental phobia after a positive experience during their emergency visit. Report 04/19/12 A 40-year old female presents to the clinic with a chief concern of facial swelling and pain. history is insignificant. Dental history includes only emergency visits due to fear of dentists. [Fear Scale of 8] Extra-oral exam revealed diffused swelling of right cheek with mandibular lymph nodes involvement. Intraoral exam showed fluctuation and pain on palpation of the mucogingival fold around teeth #26,27,28. Tooth #27 was positive to percussion and negative to endo ice. Radiographs determined tooth #27 to be hopeless (Figures 1 and 2). Diagnosis Periodontal abscess with endondotal involvement of #27 leading to necrotic pulp. Emergency treatment plan Incision and drainage of the site and extraction of #27 under local anesthesia using iplus (Biolase) using manufacture procedure setting and MZ6 tip for pain management using Epic (Biolase). Copyright imedpub This article is available in: 1
2 Figure 1 First appointment x-ray. of past dental experiences was necessary to build initial rapport so that the chief complaint could be properly addressed and establish trust (Figure 3). 04/29/12 Patient returned for bone grafting to preserve the site for an implant. Bone grafting was performed using Bio-oss and Bio guide. Vicryl sutures were utilized and primary closure was obtained. Postop appointments were scheduled the next day and the following week. 05/16/12 Comprehensive evaluation was done. Diagnosis Chronic generalized moderate to severe periodontitis. Dental caries included teeth #2, 4, 18, 20. Mild spacing. Soft tissue fibroma on lower lip. Comprehensive treatment plan 4 Quad Scaling and Root Planing, using repair protol of Biolase, excision of fibroma with iplus under topical gel Cetacaile, Resin Restorations #2, 4, 18, 20, orthodontic treatment using Clear Correct, Straumann 3.3 mm bone level implant to replace and restore site #27. The treatment was successfully completed with Biolase whitening gel using Diode lase Epic (Biolase) (Figures 4 and 5). Discussion This report highlights the history, diagnosis, and treatment of a patient with dental phobia from day 1 of the emergency walk-in to completion of a comprehensive treatment by a general practitioner. The first treatment objective for fearful patients must be to establish a trusting, professional and open relationship. Proper explanation of the procedure and educating the patient is a key factor in achieving comprehensive care. Asking non-judgmental questions and making patients aware of your concern for their comfort can help relieve anxiety and allow them to share their needs. Treatment planning should be adjusted to the patient s level of comfort i.e. a patient-centered approach. Preventive and routine dental care is essential to reduce anxiety and improve quality of health. Treatment considerations should include Figure 2 One grafting. A prescription of Amoxicillin 500mg TID for 7days and Anaprox 550mg for pain every 12 hours as needed was provided. First visit treatment considerations Extra time spent initially with the phobic patient showing care and empathy helped relieve anxiety. A thorough acknowledgement 1. Non-threatening comforting environment e.g. headphones, blanket 2. Pharmacological sedative agents pretreatment 3. Nitrous oxide sedation during treatment 4. Understanding patient s history of dental experiences and fear 5. Avoid use of the word pain 6. Allow patients to maintain control throughout their dental visit. 7. Reminder that the patient is not alone. 8. Psychiatry referral 2 This article is available in:
3 Figure 3 Before the clear correct treatment Figure 4 After the clear correct treatment. Figure 5 Implant #27. Under License of Creative Commons Attribution 3.0 License 3
4 Conclusion Successful management of an emergency patient during the first visit established good patient - dentist - staff relationship bringing the patient back in several times during the course of the year thus completing comprehensive dental treatment including bone grafting, implant placement, periodontal therapy, and orthodontics, laser assisted treatment. As a result of proper management, patient is more compliant and in improved oral health. We also saw the benefit of using Laser in phobic patient due to less bleeding, less or no pos-op pain and reduced use of anesthesia (no needles from patient perspective) 4 This article is available in:
5 References Scott DS, Hirschman R (1982) Psychological aspects of dental anxiety in adults. The Journal of the American Dental Association 104: Appukuttan D, Subramanian S, Tadepalli A, Damodaran LK () Dental anxiety among adults: An epidemiological study in South India. North American journal of medical sciences 7: Hmud R, Walsh LJ (2009) Dental anxiety: causes, complications and management approaches. Journal of Minimum Intervention in Dentistry 2: Kirpa J (2011) Fundamentals of laser dentistry. JP Ltd. Under License of Creative Commons Attribution 3.0 License 5
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EXHIBIT A PROCEDURE DESCRIPTION MSP50809 CDT CODE
D0120 Periodic Exam 28.00 D0140 Limited Oral Evaluation Problem Focused 42.00 D0145 Oral Evaluation for a Patient Under Three Years of Age and Counseling with Primary Caregiver 38.00 D0150 Comprehensive
I have been encouraged to seek a second opinion if I so desire before consenting to this surgery.
Dr has examined my mouth and made treatment recommendations to restore my teeth. The risks and benefits of the recommended treatment have been explained to me. Alternative forms of treatment including
ASSISTANT SECRETARY PRESIDENT
Charge Code TYPE I* Benefit Co-Insurance $21.00 0120* Periodic oral exam $21.00 Balance Billing $30.00 0140* Limited oral exam $30.00 Balance Billing $35.00 0150* Comprehensive oral evaluation $35.00 Balance
Revisions for CDT 2016
Revisions for CDT 2016 This document was developed from preliminary actions of the Code Maintenance Committee (CMC). This document has been compared to the CMC meeting notes and the ASCII file. This document
02130 Cavities involving three surfaces 10.00
( ) 02130 Cavities involving three surfaces 10.00 AMALGAM RESTORATIONS, PERMANENT TEETH: 02140 Cavities involving one tooth surface $ 5.00 02150 Cavities involving two tooth surfaces 8.00 02160 Cavities
INDIANA HEALTH COVERAGE PROGRAMS
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER CODE TABLES Note: Due to possible changes in Indiana Health Coverage Programs (IHCP) policy or national coding updates, inclusion of a code on the code tables
Annual Deductible, Payment Provisions and Annual Maximum
Dental Plan Dental Benefits are available only to those Participants and their eligible dependents where the Participant Group has opted for this coverage and completed an enrollment form requesting coverage